Metoclopramide for breast milk production

Abstract

The efficacy of a dopamine antagonist-metoclopramide to recommend for healthy mothers with lactational insufficiency was evaluated in healthy mothers with lactational insufficiency. Thirty-two mothers with babies 10 days to 120 days of age who had inadequate lactation confirmed by failure to gain weight of their babies and two consecutive measurements of breast milk by pump that proved to be less than the daily requirements of the baby. The drug was started to the mothers with lactational insufficiency only after a brief educational period to make sure the proper technique for breast feeding being used and a second measurement one week later that was still less than the requirements of the baby. Mothers were given 300–500μgr/kg of metoclopramide (10 mg×3) in 3 divided doses orally. A control group of 32 mothers with adequate lactation was also included in the study. A ‘true control group’ of women with lactational failure that placebo should be given was not approved by the ethical committee. The therapy group and control group were comparable in parity, socioeconomic status, age of the mothers and the age of the babies. About half of the babies were premature in each group. The amount, (twice in the initial measurement) and the osmolality of breast milk, the blood pressure, prolactin and aldosterone levels of the mothers, and maternal blood counts, ferritin and serum iron and iron binding capacity were determined. The laboratory analyses were repeated after 15 days both in the drug therapy and control groups. Daily milk production increased by 28.5%. (from 378±28(SD) ml to 690±37ml) which was statistically significant (P<0.001). An increase of 34% in prolactin levels were also recorded from 69.5SI(2293μIU/ml) to 93.3 SI (3079μIU/ml) which was also significant (P<0.05). Aldosterone levels were also increased in the therapy group but did not exceed the mean levels of the control group. Blood pressure levels of the mothers and the osmolality of breast milk did not differ significantly after the drug. However in mothers of term babies an increase in the osmolality of breast milk was noted. This effect was not recorded in the mothers of premature infants. The elevation of the osmolaiity of milk was most evident in subjects who had higher blood pressures initially. Initial prolactin levels were inversely correlated with initial diastolic pressures. The increase of daily milk production significantly and inversely correlated with the age of the mothers (P<0.01, r=−47). No. significant side effects were recorded in the mothers of babies. 25 of 32 (78%) mothers had a sufficient response (meeting the daily calorie and liquid requirements of the infant) to metoclopramide. In seven treated mothers daily milk production was still below the infants' daily requirements. These mothers were relatively older in age, no other factors were associated with failure of response to metoclopramide. Metoclopramide seems to be a safe and effective drug for the treatment of lactational failure especially in young mothers and is worth a trial before recommending formula feeding even in mothers of premature babies.